- CMS: Medicare and Medicaid Programs: CY 2026 Payment Policies Under the Physician Fee Schedule and Other Changes to Part B Payment and Coverage Policies; Medicare Shared Savings Program Requirements; and Medicare Prescription Drug Inflation Rebate Program
- Public Inspection: CMS: Medicare and Medicaid Programs: CY 2026 Payment Policies under the Physician Fee Schedule and Other Changes to Part B Payment and Coverage Policies; Medicare Shared Savings Program Requirements; and Medicare Prescription Drug Inflation Rebate Program
- CMS: Medicare Program; Implementation of Prior Authorization for Select Services for the Wasteful and Inappropriate Services Reduction (WISeR) Model
- Public Inspection: CMS: Medicare Program: Implementation of Prior Authorization for Select Services for the Wasteful and Inappropriate Services Reduction Model
- CMS: Secretarial Comments on the CBE's (Battelle Memorial Institute) 2024 Activities: Report to Congress and the Secretary of the Department of Health and Human Services
- HHS: Patient Protection and Affordable Care Act: Marketplace Integrity and Affordability
- Public Inspection: HHS: Patient Protection and Affordable Care Act: Marketplace Integrity and Affordability
- Increased Risk of Cyber Threats Against Healthcare and Public Health Sector
- HRSA Announces Action to Lower Out-of-Pocket Costs for Life-Saving Medications at Health Centers Nationwide
- Announcing the 2030 Census Disclosure Avoidance Research Program
- Eight Hospitals Selected for First Cohort of Rural Hospital Stabilization Program
- CMS: Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System and Policy Changes and Fiscal Year 2026 Rates; Requirements for Quality Programs; and Other Policy Changes; Correction
- CMS: Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System and Policy Changes and Fiscal Year 2026 Rates; Requirements for Quality Programs; and Other Policy Changes; Correction
- CMS: Medicare and Medicaid Programs; Contract Year 2026 Policy and Technical Changes to the Medicare Advantage Program, Medicare Prescription Drug Benefit Program, Medicare Cost Plan Program, and Programs of All-Inclusive Care for the Elderly; Correction
- CMS: Medicare and Medicaid Programs; Contract Year 2026 Policy and Technical Changes to the Medicare Advantage Program, Medicare Prescription Drug Benefit Program, Medicare Cost Plan Program, and Programs of All-Inclusive Care for the Elderly; Correction
Things You Need to Know about Community HealthChoices
Community HealthChoices (CHC) is Pennsylvania’s mandatory managed care program for individuals who are dually eligible for both Medical Assistance and Medicare–older adults and individuals with physical disabilities. This program was implemented in southwestern Pennsylvania in January 2018, southeastern Pennsylvania in January 2019, and will be implemented in the remainder of the state on Jan. 1, 2020. CHC information for providers or participants can be found at www.healthchoices.pa.gov. Fact sheets and online trainings can be found here. Access a list of frequently asked questions (FAQs) about CHC by clicking here. To become part of the provider network contact:
- AmeriHealth Caritas: 1-800-521-6007; email: chcproviders@amerihealthcaritas.com
- Pennsylvania Health & Wellness: 1-844-626-6813; email: information@pahealthwellness.com
- UPMC Community HealthChoices: 1-844-860-9303; email: CHCProviders@UPMC.edu
Pennsylvania Senate Advances Telemedicine Bill
During the week of October 28, 2019, the Pennsylvania Senate quickly fast-tracked a telemedicine bill that nearly made it to Governor Wolf’s desk last December. Senate Bill 857 expands the use of telemedicine for providers, including Community Health Centers , to provide care and receive reimbursement from both managed care organizations (MCOs) and commercial insurance. One new caveat to the bill is a requirement for any affected licensure boards overseeing specialties to promulgate regulations within 24 months of passage. As of October 30, the legislation is before the House for consideration.
Pennsylvania Partnerships for Children’s Annual State of Children’s Health Care Report Released
The opportunity to prosper begins with preventive health care when children are young. A healthy start includes immunizations, screenings, regular dental care, well-child visits and access to nutritious food. However, 124,000 Pennsylvania children do not have health insurance, and children under six are the most likely to be without coverage according to our newest report, “State of Children’s Health Care in Pennsylvania: Powering Up Healthy Kids.”
While Pennsylvania’s uninsured rate falls below the national average, it remains stagnant at 4.4 percent, with Pennsylvania ranking in the middle of the pack at 24th for the percentage of uninsured children.
According to a new report released by the Georgetown University Center for Children and Families, the number of uninsured children increased nationally by more than 400,000 between 2016 and 2018, reversing a long-standing positive trend.
No child should be without health care insurance and our report sets a clear agenda to strengthen both access and coverage benefits in health care for the Commonwealth’s children.
A New Website for Substance Use Disorder Care
(AP/PBS Newshour, 10/30/19)
The Trump administration has launched a website intended to help people connect with treatment options for substance use disorders. The website, FindTreatment.gov, includes customizable tools that allow users to search for providers based on the type of treatment they want—including detox, inpatient, or telemedicine—and by payment method and insurance type.
Research: Policy Change and Implementation of a Needle Exchange Program Averts More than 10,000 Potential Diagnoses of HIV
Syringe exchange programs (SEP) reduce HIV incidence associated with injection drug use (IDU), but legislation often prohibits implementation. We examined the policy change impact allowing for SEP implementation on HIV diagnoses among people who inject drugs in 2 US cities.
Using surveillance data from Philadelphia (1984–2015) and Baltimore (1985–2013) for IDU-associated HIV diagnoses, we used autoregressive integrated moving averages modeling to conduct 2 tests to measure policy change impact. We forecast the number of expected HIV diagnoses per city had policy not changed in the 10 years after implementation and compared it with the number of observed diagnoses postpolicy change, obtaining an estimate for averted HIV diagnoses. We then used interrupted time series analysis to assess the immediate step and trajectory impact of policy change implementation on IDU-attributable HIV diagnoses.
The Philadelphia (1993–2002) model predicted 15,248 new IDU-associated HIV diagnoses versus 4656 observed diagnoses, yielding 10,592 averted HIV diagnoses over 10 years. The Baltimore model (1995–2004) predicted 7263 IDU-associated HIV diagnoses versus 5372 observed diagnoses, yielding 1891 averted HIV diagnoses over 10 years. Considering program expenses and conservative estimates of public sector savings, the 1-year return on investment in SEPs remains high: $243.4 M (Philadelphia) and $62.4 M (Baltimore).
The authors conclude that pPolicy change is an effective structural intervention with substantial public health and societal benefits, including reduced HIV diagnoses among people who inject drugs and significant cost savings to publicly funded HIV care.
Access the full report here.